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MO HealthNet
E Tools Chronic Care and P4P
Medicaid Purchasing Leadership Summit
March 27-28, 2008
George L. Oestreich, Pharm.D., MPA
Deputy Division Director, Clinical Services
MO HealthNet Division
4/7/2008 MO HealthNet Division 1
Elements of Healthcare Home
Access and Communication
Patient Tracking and Registry Functions
Care Management
Patient Self-Management Support
Electronic Prescribing
Test Tracking
Referral Tracking
Performance Reporting and Improvement
Advanced Electronic Communications
4/7/2008 MO HealthNet Division 2
Mapping & Data Integration
Diagnosis
Membership Drug
Pharmacy
Integrated
Claims
Data Repository
Medical Hospital Laboratory
Claims Office
Reference ER
Data
4/7/2008 MO HealthNet Division 3
Clinical Rules System
Clinical & Table-driven criteria;
easily & rapidly
Business modified
Integrated drug,
Rules
diagnostic,
procedure & Claims involved in cases
encounter data where there are
opportunities for
improvement
Client Rules Flagged
Data Engine Claims
4/7/2008 MO HealthNet Division 4
Self-Service Model
Evidence
Based
Treatment
Outputs:
Guidelines Reports MD & Rx
Clinical Clinical Scores
Data PDL Risk Assessments
Treatment Suggestions
Trending Health
PA/Utilization Behavioral Suggestions
Management Therapy Alternatives Portal Payor
Criteria Cost Savings
Claims
Case Management
Data DM Assignment
Analytics PA Approval
Rules
Engine Consumer
4/7/2008 MO HealthNet Division 5
Driving Change Through
Technology
4/7/2008 MO HealthNet Division 6
Provider Portal…CyberAccess
4/7/2008 MO HealthNet Division 7
Direct Care Pro
Allows Provider to Interact With State Systems
Notification of
Potential Intervention
Reserve Intervention
Perform Intervention
Directly Bill for
Services
4/7/2008 MO HealthNet Division 8
Participant Portal
Print Personal Medical Profile
•
Medical and RX Claims history
•
Heath Alerts
Bring the profile to discuss with
you’re physician
4/7/2008 MO HealthNet Division 9
Targeted Clinical Information and
Personal Health Record
Members may add additional
Personal & Demographic
Data
•Weight
•Height
•Blood Type
•Age
•Home lab values
•OTC Medications
4/7/2008 MO HealthNet Division 10
Seamless Link to Case Management
Tool (Care Connection)
4/7/2008 MO HealthNet Division 11
Case Manager/Provider Interface
4/7/2008 MO HealthNet Division 12
Missouri CCIP Per-Member Per-
Month (PMPM) Expenses
PMPM Expenses By Condition
P e r M e m b e r P e r M o n th
5000 4108
3830 3708
4000
E x pe ns e s
2734 2789 2673 2864
3000 2471 2391 2633
2431 2502 2317 2136
2000
1000
0
Asthma CAD CHF COPD Diabetes GERD Sickle Cell
Disease
2006
2007 (through September)
4/7/2008 MO HealthNet Division 13
Missouri CCIP Asthma Pharmacy
Utilization
Asthma Participants Who Received Inhaled Corticosteroids
(N = 10,455)
% o f P o p u la t io n
100%
80%
55%
60%
46%
40%
20%
0%
Inhaled Cort icost eroids
2006 2007 (projected based on actual results through September)
4/7/2008 MO HealthNet Division 14
Missouri CCIP Coronary Artery
Disease (CAD) Outcomes
Participants with CAD Who Received Lipid Testing
(N = 13,724)
100%
% P a r tic ip a n ts
80%
60%
47% 45%
40%
20%
0%
Lipid Panel
2006 2007 (projected based on actual results through September)
4/7/2008 MO HealthNet Division 15
Missouri CCIP Coronary Artery
Disease (CAD) Outcomes
Participants with CAD Who Received Statin Medications
(N = 13,724)
100%
% Participants
80%
69%
54%
60%
40%
20%
0%
One or More Prescript ions f or St at ins
2006 2007 (projected based on actual results through September)
4/7/2008 MO HealthNet Division 16
Missouri CCIP Congestive Heart
Failure Utilization
Participants with CHF Who Received Cardiovascular Medications
(N = 5,543)
100%
% P a r t ic ip a n t s
75% 84%
80% 71% 72%
69%
58%
60%
40%
20%
0%
ACE/ARB Rx Beta Blocker Rx Diuretic Rx
2006 2007 (projected based on actual results through September)
4/7/2008 MO HealthNet Division 17
Missouri CCIP COPD Pharmacy
Utilization
Participants with COPD Who Received Bronchodilator Medications
(N = 1,677)
100%
% P a r t ic ip a n t s
80%
57%
60%
43%
40%
20%
0%
Bronchodilator Rx
2006 2007 (projected based on actual results through September)
4/7/2008 MO HealthNet Division 18
Missouri CCIP Diabetes Outcomes
Participants with Diabetes Who Received Screening Examinations
(N = 16,076)
100%
% P a r t ic ip a n t s
80%
68%
57%
60%
47% 45%
31% 37%
40%
19% 18%
20%
0%
HbA1c Lipid Panel Eye Exam Microalbumin
2006 2007 (projected based on actual results through September)
4/7/2008 MO HealthNet Division 19
Missouri CCIP GERD Utilization
Measurements
ER & Hospitalization Rates for GERD Participants
(N = 7,819)
25
21
P a r t ic ip a n t s
20
16
15
12
9
10
5
0
ER Visits per 1,000 Participants Hospitalizations per 1,000 Participants
2006 2007 (projected based on actual results through September)
4/7/2008 MO HealthNet Division 20
Pay for Performance Metrics
All Participants (Excluding GERD)
Providing Influenza Immunization
Providing Pneumococcal Immunization
Asthma and COPD (20%)
Use of Inhaled Corticosteroids
Cardiovascular Disease (38%)
Use of ARB or ACEI in CHF
Use of Beta blockers in CHS
Managing Hyperlipidemia
Lipid profile
Statins if indicated
Gastroespohogeal Reflux (8%)
Attempt to Step-down H2A or PPI Therapy
Diabetes (34%)
Hemoglobin A1c Monitoring
Controlling Hyperglycemia
Performance of Dilated Retinal Exams (DRE)
Performing Urinary Micro albumin Tests
4/7/2008 MO HealthNet Division 21
Discussion
Questions?
George.L.Oestreich@dss.mo.gov
573.751.6961
4/7/2008 MO HealthNet Division 22
